CN-370000-GC923-T5CO1.pdf
PDF 534 KB Posted
- Contract number
- GC923
- Issued by
- Florida
About this file
This document is a Task Assignment Change Order Form (OOO-012) issued by the Florida Department of Environmental Protection (FDEP). The form documents Change Order No. 1 for Task Assignment GC923, dated November 2, 2021, involving Polk County as the contractor. The contractor representative is Steve Jarrett, and the DEP Contract Manager is Roger Ruiz. The change order was approved by Tameshia N. Reid (Budget Representative) and Teresa Booeshaghi (Contractual Authority).
The change order modifies the performance measures for the contract due to unforeseen circumstances. Specifically, the contractor is required to complete 31 percent, or 133 Routine Compliance Inspections, within the first four months of the performance period. The original task amount remains $267,672.00 with no net increase or decrease in task amount. The task completion date is maintained at June 30, 2022 (06/30/22), with no change in the task period. Funding is allocated under Org. Code 37450104000, E.O. JD, Object Code 132500, Budget Entity 37450300, Special Category 100029, for a total amount of $267,672.00.
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Text version
OOO-012 (Effective 09-14-2015) Page 1 of 2
Florida Department of Environmental Protection
TASK ASSIGNMENT CHANGE ORDER FORM
Required Signatures: Adobe Signature
Task Assignment Number: __________________ Date: _______________ Change Order No.______________
Contractor Name: _________________________________________________________________
Contractor Representative: __________________________________________________________
DEP Contract Manager:
Description of Change (Use additional sheets if necessary):
Change in Task Amount
Item Cost Reimbursement Fee Schedule Total Original Task Amount:
Task amount prior to this change order:
Net increase/decrease in task amount:
Task amount with all change orders:
Change in Task Time
Original task completion date:
Completion date prior to this change:
Net increase/decrease in task period:
Completion date with all change orders:
GC923 11/02/2021 1
POLK COUNTY
Steve Jarrett
Roger Ruiz
Performance Measures:
Due to unforeseen circumstances GC923 Polk County, for the first Performance Measures after (4) four months shall complete (31%) or 133 Routine Compliance Inspections.
267,672 267,672
06/30/22
OOO-012 (Effective 09-14-2015) Page 2 of 2
Florida Department of Environmental Protection
TASK ASSIGNMENT CHANGE ORDER FORM
Change in Funding Information
Org. Code E.O. Object Code Budget Entity
Special Category
Grant # Year Amount
CONTRACTOR FLORIDA DEPARTMENT OF
ENVIRONMENTAL PROTECTION
Contract Manager Date Contract Manager Date
APPROVED:
Budget Representative Date
Contractual Authority Date cc: Procurement Section (MS93) Bureau of Finance & Accounting (MS78) - 2 copies
37450104000 JD 132500 37450300 100029 00 $ 267,672.00
Digitally signed by Steven Jarrett DN: C=US, OU=Storage Tank Regulation, O=Florida Department of Health in Polk County, CN=Steven Jarrett, E=steven.jarrett@flhealth.gov Reason: I have reviewed this document Location: your signing location here Date: 2021-11-02 10:12:41 Foxit Reader Version: 9.7.2
Steven Jarrett 11/02/2021 Roger Ruiz Digitally signed by Roger Ruiz Date: 2021.11.02 10:26:11 -04'00'
Tameshia N. Reid Digitally signed by Tameshia N.
Reid Date: 2021.11.02 10:35:36 -04'00'
Teresa Booeshaghi Digitally signed by Teresa Booeshaghi Date: 2021.11.02 10:41:08 -04'00'
File details come from the government source that posted it. Updated .